HIV and Racism as a Barrier to Testing and Treatment

Seattle is a city where whiteness and maleness reign supreme, including in gay spaces. Risk for HIV acquisition can be increased by further oppression among the oppressed, or a kind of hierarchy of layered oppressions. Trans women of color have been the absolute backbone of the gay rights movement. But most white gay cisgender men don't know who revolutionary foremothers such as Marsha P. Johnson, Sylvia Rivera, and Miss Major even are. But ask a gay white man who Harvey Milk is, and we're quite sure this is a name they will have heard of.

History denies the importance of people of color, and gay white men need to work harder to pay homage to the real people who fought for our rights as LGBTQIA people to walk down street unafraid. Racism in the gay community at large is a huge issue, but racism as a barrier to accessing testing and treatment for HIV is an issue that is rarely discussed in white-dominated gay communities.

You would think that if you identified as a gay white man, then you would understand the historical factors and experiences that play out for folks who identified as a queer person of color, but unfortunately, gay men -- especially gay white cisgender men -- often don't. They often are the people who continue to perpetuate stereotypes, behave in violence, co-opt aspects of culture of communities of color, and remain just pure ignorant of the experiences that queer persons of color deal with on a daily basis. White gay cisgender men are almost conditioned to believe that everyone who is part of the LGBTQIA community must be doing well. This is false.

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Queer and trans people of color repeatedly experience the harsh realities that flourish in systemic and institutional racism. Especially in predominantly white cities such as Seattle, queer and trans people of color, especially black queer folks, are so isolated and attacked that we are driven to leave or hide. Hiding is not safety.

Every day, when people of color attempt to seek HIV-related services, they are met with an overwhelmingly white-dominated health care infrastructure that is culturally unprepared to engage people of color. Whiteness is not the universal language of all people. People of color, especially black communities in the U.S., have historically had to suffer major consequences from living in a country that prioritizes only the physical and mental health needs, beliefs, and experiences of white people.

According to AIDsVu.org, even though black people made up only 5% and Latinx folks only 9% of Seattle's population at the time of the last census in 2010, they respectively accounted for nearly 20% and 14% of people living with HIV in 2016. In fact, in Seattle, black males are over three times as likely as white males to be diagnosed with HIV, and black females are nearly 23 times more likely than white females to be diagnosed. Latinx males are twice as likely and Latinx females are more than three times as likely as their white counterparts to have HIV. Despite living in an overwhelmingly white city, we are still disproportionately impacted by HIV.

From the Tuskegee Syphilis Experiment to documented forced sterilization of black and Latinx people in the U.S. and abroad, there is really no reason for the black, Latinx, or Native American communities to trust a medical system that was rooted in and based on black oppression and exploitation. For this to be dismantled, the intense racism that modern western medicine was founded upon must first be recognized, and too often providers -- namely white medical providers -- are too uncomfortable to acknowledge how historical racism can impact the ways in which a person of color living with HIV may feel about discussing barriers to testing or treatment with a white provider. Lack of competent providers who are trained in trauma-informed care and what it means to be queer and/or trans and a person of color are a real deterrent to marginalized folks obtaining services, for example when going into a clinic for HIV testing or treatment services and not seeing anyone working there who looks like you.

Even access to care can be a problem, as queer people of color are disproportionately affected by social issues such as poverty and housing instability. King County, Washington, in which the wealthy city of Seattle and outlying suburbs sit, has robust services for HIV care, but if someone cannot afford to live in this wealthy and quite expensive county, then naturally getting to a competent HIV clinic will prove to be an issue. Additionally, Seattle has an exploding population of folks experiencing homelessness, and what we know of HIV care is that if one does not have a safe, stable place to access their medications, then it is virtually impossible to stay on treatment, come in regularly for labs, etc. Luckily, in Seattle we have a very special HIV clinic called the MAX Clinic out of Harborview Medical Center, which provides specialized monetary incentives for people living with HIV who are difficult to reach and have problems staying connected to care. These sorts of models are ideal and need to be expanded.

Given that the men who have sex with men (MSM) community has one of the higher prevalences of HIV, it's understandable that most places that provide HIV testing, care, and treatment are also dominated by cisgender gay men. However, this needs to change. Representation and alienation can be huge barriers to accessing spaces to get tested for HIV and receiving HIV care and other services for people of color. If HIV intervention and prevention centers are modeled after the needs of white gay cis men, then we are leaving a huge number of people behind and actually promulgating barriers to treatment for people of color.

The only way we can stop the spread of HIV and truly see the epidemic fade into history is to have equitable access to services for all people of color, women, trans folks, and those not given proper space in HIV services. This means ensuring that everyone is able to access care (such as, is a competent HIV clinic nearby? Can someone living with HIV receive bus tickets or a taxi to get to or from their appointments if they do not have reliable transportation, is there a safe place that someone can store their medications if they are housing unstable?) Then, there are the more nuanced needs, such as: Does a person feel comfortable talking to their provider? Do they feel safe enough to talk about the barriers to testing and treatment that arise when one is a queer person of color?

It's shameful to think that some of the very trans women of color who played key roles in launching the gay rights movement would not be welcome in many of the spaces that they put their lives on the line to start or to protect. If you are a cisgender gay man, particularly a cis gay white man, you have a lot of privilege in this country -- privilege that you can utilize for the benefit of those around you who don't have it. To make queer spaces safe for all, particularly spaces aimed at gay cis men that provide HIV testing and care, those in privilege need to be honest with themselves about whose needs are being catered to and who is (still) being made invisible in the world of HIV testing and treatment.

Tranisha Arzah has been a member of the BABES-Network since 2010 and has worked there as a peer advocate since 2013. Having lived with HIV since birth in 1990, Tranisha has been educating and advocating on behalf of vulnerable and marginalized communities, including young people, queer, and trans people of color, as well as women in Seattle and surrounding areas. She also serves on the board of directors of Positive Women's Network-USA.

Jake Ketchum is a person living with HIV and an HIV advocate working in public health. He has a strong passion for community and social justice. In his downtime, he can be found spending time with his family and reading car magazines.

Laura LeMoon is a sex worker, trafficking survivor, and writer based in Seattle. She has written for them Huffington Post and is the co-founder of Safe Night Access Project Seattle, a nonprofit aimed at providing outreach to street-based sex workers. She can be found eating Mexican food in bed with her dog, Little Bear.

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